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HomeMy WebLinkAboutBuilding Permit ApplicationC • J ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTE Date: • j 7 Permit Nu /7//• 0,5;,L2. • Building Permit Application NOV 2 0 2017 Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce F134982 / Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential to I PERM IT APPLICATION FOR: To Select from dropbox, click arrow at the end of iline fi"; a i t2 h PROPOSED IMPROVEMENT LOCATION: 1 Address: 02 y SArAMLE f3iO4 1)2 I Ur DU4T S%.G/F- F-L Legal Description: _5,494— G (MZSY PItz L©7— 9f � Property Tax ID #: DYe — OO© — O Lot No.�_ Site Plan Name: Block No. Project Name: _&1 L l GAP 6 AR, Setbacks Front_ Back Right Side: 2�.'20' Left Side: DETAILED DESCRIPTION'OF W&Rk rJ - Ctr2 6 /94-6E C-rA6t)rW) Ct36 60n/5jTE41CTi0AJ I CONSTRUCTION INFORMATION: Y AcIclitional work to e e orme under this permit— check aM y: app [1HVAC I []Gas Tank Gas Piping H_ Shutters a Windows/Doors ®Electric E] Plumbing Sprinklers -. Generator Q Roof Roof pitch Total Sq. Ft of Construction: wf y S . Ft. of First Floor Cost of Construction: }DL1® Utilities: Lj Sewer 035eptic - Building Height: r I I .OWNER/LESSEE: CONTRACTOR:;'II , Name M /160 /Qk& Vr—ifi4 Name: Address: Company: City: PL,�'LTSE.(-(/C,(C State:�L- ;;Address: Zip Code: Fax: City: % 4 k 1i .cST- LG1C%� State: C, —7 Phone No. Y- 19 °S . /�. Zip Code: Fax:77Z E-Mail: Phone No. Fill in fee simple Title Holder on next page (if different E-Maik'. IL)Af k& NE 4/3,�=LLSUu7�/, /VAT from the Owner listed above) State or County License: CC7C/5c;la I � If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. - 1 , SUPPLEMENTALCONSTRUCI"ION,.LIEN"LAW INFORMATION"r DESIGNER/ENGINEER: _ Not Applicable Name: ?Pfitij (`� EU14 MORTGAGE COMPANY: 1_ Not Applicable Name: Address: /3 ' - AWk7UTA IN 15 City: er-zvol State: rb Zip: Phone Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: BONDING COMPANY: j_Not Applicable Name: Address: Address: City: City: Zip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the workiand installation as indicated. I certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owners Association and review your deed for any restrictionswhich may apply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another 'non-residential use WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite before the first inspection. If you intend to obtain financing, consult with fender or an attorney before ur Notice of Commencement. Signature of Owrier/ Lessee/Contractor as AgentRs EIS Signature of Cod, it c ;b MI- ! V %1m..• ��__ I STATE OF FLORI "'' ' " STATE OF FLORIE COUNTY OF W A#W COUNTY OF x� a The forgoing instrument wa acknowledgg4ef ezme The fpw�tng instr thi day of 20_ by c. j this day of r� m � 0 s e Nam6 of perso ing statement Nara of pe Personally Known OR Produced Identifi dog" Personally Known _ Type of Identification Type of (dent' ' tioi Produced Produced (Signature of Not Public -State of Florida) (ignature o tarp Commission No. (Seal) Commission No.u. icenssee Holder Vqs ackn ledged efore me � 20by or :e making statement _ OR Produced Identification i 1\ J Public-`%tate c a5790S lo�rla ), YENIA NOY RIOS c Notary Public. Sat of Florida 1} Commission My Bddifh: oxpire G B 57808 : 22, 2020 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA'TURTLE MANGROVE COUNTER RfVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED I DATE COMPLETED tev. 8/2/17